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Hyperpigmented lesions like giant con-genital nevus (GCN)
(the largest diameter greater than 20 cm) are very rare. This baby had
many nevi on various parts of the skin covering about 30% of surface
area. The largest nevus covered large part of left cheek, left ear pinna,
left temporal area of scalp, neck, anterior part of chest, and a large
portion of back and measured 32 cm in circumference and 20 cm in highest
width. There were many satellite lesions scattered over scalp, trunk,
and limbs (Fig. 1).
All lesions were black colored and had well defined, and raised edges.
The surface of the largest lesion was rough and nodular at places. Some
leisons had smooth surfaces also. Hair were present at surface of some
lesions at the back. Other physical examination was normal except a
lacerated wound in front of left ear that resulted from application of
forceps. There was no evidence of clubfoot, meningomyelocele, or any
other congenital anomaly. Histopathological find-ings were consistent
with giant congenital melanocytic nevus (compound type).
The management of this condition is controversial.
The best is to have complete excision but when such a large part of the
skin is involved, partial removal of superficial nevus cells by
dermabrasion, laser therapy, curettage, or shave excision is less
traumatic than excision surgery and produces acceptable cosmetic result.
However, presence of neural melanosis makes these efforts futile.
Further, none of these techniques or excision of GCN to superficial fat
completely removes the risk of malignant melanoma transformation. The
overall incidence of malignant melanoma arising out of GCN is estimated
to be approximately 5-10% and 50% of these transformations occur by the
age of 5 years.
Fig. 1. A neonate
with giant congenital melanocytic nevus.
Kamlesh Harish,
Specialist-Pediatrics,
E.S.I. Hospital,
Rohini Sector-15,
New Delhi 110 085,
India.
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